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Making health equity sustainable: Helping patients and the bottom line


Ankoor Shah of Accenture talks with Chief Healthcare Executive about the need for better data, and why technology is a key element in closing disparities.

For Ankoor Shah, health equity is deeply personal.

Shah, a principal director and health equity lead at Accenture, worked for years as a practicing physician in southeast Washington, D.C., where disparities in outcomes are much different than the more affluent neighborhoods in the nation’s capital.

“I had a child who unfortunately passed away from asthma,” he says. “And it haunts me to this day because I think about, if that child had that exact same diagnosis, but grew up in … Georgetown, would probably be alive today.”

Accenture recently released a report on how hospitals, health systems, and the entire healthcare industry, can close disparities in outcomes.

“It's essentially a playbook for hospital CEOs, payers and across the life science and public health ecosystem for how to make it sustainable,” he says.

In a recent interview with Chief Healthcare Executive®, Shah discusses the importance of data and technoogy in closing disparities, the need for culturally compassionate care, and why improving health equity is a sound business strategy.

“There is a lot of opportunity in that space in which we can make health equity, not just a topic of conversation anymore, but something that is measurable, and sustainable, that will improve care for all,” he said.

(See part of our conversation with Ankoor Shah in this video. The story continues below.)

Getting better data

The social determinants of health, where we live, work, and play, account for about 80% of individuals' health outcomes, Shah says. Housing, food, education and transportation all exert enormous influence on health. And some see vastly different health outcomes due to their zip code.

“The reasons these disparities exist is because of historic and structural racism,” Shah says.

Part of the solution in closing those disparities is mitigating bias in data. Health systems need more than medical histories of patients. They need the social history of patients, such as their housing or transportation situations.

“We need those data silos to be broken, to be connected, so that the primary care physician can have a 360-degree view of the individual to really know what not only medical need,needs to have an intervention, but what social need to only have intervention, and how can we tie that to a financial and health outcome,” Shah says.

There’s a glaring need for better data, Shah says. Health plans have “a fraction” of the data they need on race and ethnicity. And that makes it more difficult to identify the drivers of disparities.

“We do not have good baseline data,” Shah says.

Ultimately, it comes down to trust. Some members of minority groups don’t trust the healthcare establishment, with valid reasons. Health plans and health systems can work to explain that they are aiming to get more information on race and ethnicity, not to limit care, but to improve care.

Healthcare organizations can work to develop culturally competent care to build trust, he says. They can also work with companies such as Violet Health, Spora Health, and SameSky to improve training and education in delivering culturally competent care.

“That trust barrier is something that you can actually tangibly work on,” he says.

Reinventing care delivery

Ultimately, health systems are going to have to rethink the way they deliver care, Shah says.

Hospitals and healthcare organizations must embrace technology to reach more patients. Shah says it’s not just a business question for hospitals, but a key concern when it comes to health equity.

Many in the clinician workforce are approaching retirement age, a growing physician shortage looms, and the number of Americans above the age of 65 is going to soar in the next decade.

“We have a lot of demand, and not enough supply,” Shah says. “So this mismatch, we do not believe there is a human solution to it. It's going to be technology that enables that.”

Shah says health systems must utilize technology such as telehealth to care for more patients, as well as solutions that offload some administrative tasks so doctors and nurses can focus on caring for patients.

“The reason why this is a health equity concern is that when there is a supply and demand mismatch, it's not you or I that will limit our access to care,” Shah says. “It's the most vulnerable among us.”

“So if we do not solve this problem right now, and really reinvent how we think about care delivery in the place, a patient wants it, how they want it, when they want it, then it's the most vulnerable that will get left behind. And having that mindset helps us think about what technology solutions we need,” Shah says.

Healthcare organizations need to think about meeting the growing demand with technology now to be prepared for the challenges ahead.

“Those companies that think about it now will be best positioned to care for their communities in the future,” Shah says.

Linking to business goals

More healthcare leaders are talking about efforts to improve health equity. A year ago, Accenture did a study and found that a large number of health systems set goals on closing disparities, but many weren’t budgeting for it.

Shah says he’s seeing more organizations making progress.

“There's a lot of talk, which is good, which is important,” Shah says. “But the folks that have been talking for the last two years, are now saying, ‘Okay, I'm done talking, let's talk about action, as well.’”

Many healthcare organizations are installing chief health equity officers, but successful systems aren’t stopping with that step. Health systems seeing the most progress are using the chief equity officer as a guide, but the C-suite and the board of directors are heavily involved and setting health equity as a top priority of the system.

It’s critical to link health equity with the business goals of the system.

“We're not only talking about reducing health disparities, saving lives, which is the most important thing,” Shah says. “But there's a financial return when you do that.”

“And in this climate, those who were thinking, or who are connecting health equity, as a business priority, are the ones that are going to see it, as opposed to those who are relegating health equity to the philanthropy or marketing arm of the organization, and funding programs that don't have a sustainable path to the future, nor connected with actual long-term results of the business objectives.”

Health systems can consider tying executive compensation toward progress on health equity, Accenture suggests in the report.

“When we align executive pay and strategic goals, the execution follows,” Shah says. “There's a natural incentive for execution.”

‘It makes financial sense’

Health systems can work on improving equity in a relatively inexpensive way by training staff to recognize implicit biases and improving cultural competency to deliver better care.

If a transgender male has a poor experience with a health system, that patient is unlikely to return, and that’s a loss for the system. If healthcare workers have better training in working with patients from minority or underserved groups, the system can build long relationships with those patients.

“It makes financial sense, because these patients are going to come back,” Shah says.

“It's a shift in thinking,” he adds. “It's a way in which you can think about your patient population and how you serve your patient population as well.”

Health systems, including smaller hospitals, can begin by focusing on one area, such as setting a goal of reducing hospital readmissions among Black or Hispanic patients. When a system can gain success in that area, the organization has a model that can be applied to other quality measures, such as post-operative infections.

Even smaller systems should consider investing in tools to apply advanced analytics to gain insights in their electronic health records.

“It's going to be the state of play in the future,” Shah says. “And you're able to reap those financial rewards now, and the health rewards as well.”

While health systems should support an innovation culture in trying novel ways to improve health equity, it’s important to consider linking efforts to organizational goals.

If a program is aimed at closing disparities in Black patients, he says, is it connected to reducing readmissions?

“You want to continue to innovate, you want to continue to experiment, try new ideas,” Shah says. “But you want to have a point in which you have a pathway to scale that idea, and to have it sustainable, financially sustainable as well.”

Health systems should be reaching out into their communities to get a sense of priorities in improving health equity. Shah says equity strategies will be more successful - and sustainable - when they are led by the community and supported by the health system and philanthropy efforts.

Ultimately, successful health equity initiatives emerge from partnerships.

“We have our philanthropy arm, your health system, your payers, or community-based organizations, the actual community, we all have to figure out how to work together,” Shah says. “Because the best the success we see is when a payer and a provider come together and think about how can we really think of innovative ways to really improve health outcomes?”

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